Eradicating Mother-to-Child HIV Transmission: Where We Are and Where We Need to Go

amfAR-Sponsored Congressional Briefing

Around 370,000 children were born with HIV in 2009. These HIV-positive orphans in Cambodia are cared
for by New Hope for Cambodian Children.

February 4, 2011—Is the eradication of mother-to-child transmission of HIV possible? If so, how can we achieve it?

HIV has been virtually eliminated among children in the industrialized world, thanks to the use of antiretroviral drugs to block mother-to-child HIV transmission. And as access to anti-AIDS drugs has expanded globally, the proportion of HIV-positive women who receive drugs to protect their offspring from infection has continued to rise—from 33 percent in 2007 to 53 percent in 2009.

Preventing hundreds of thousands of HIV-positive mothers from passing the virus to their children “is one of the startling successes in the response to the global AIDS epidemic,” said amfAR Vice President and Director of Public Policy Chris Collins in his opening remarks at an amfAR-sponsored Capitol Hill briefing on January 31.

Recognizing these extraordinary gains—and the imperative of extending these gains further—a panel of experts at the Washington, D.C., briefing highlighted the challenges to fully eradicating mother-to-child HIV transmission The briefing brought together experts from the U.S. government, foundations, and NGOs that sponsor prevention of mother-to-child transmission (PMTCT) services.

The challenge now, the experts agreed, is to capitalize on those advances and determine the best ways to reach vulnerable women and children in an era of funding cuts—and, often, in the face of stigma.

“It really starts with educating mothers, educating families, and creating community demand for services such as antenatal care, HIV testing, and peer support,” said Charles Holmes, M.D., M.P.H., chief medical officer for PEPFAR. Services funded by PEPFAR prevented 114,000 mother-to-child infections in 2010 alone, although HIV/AIDS is the leading cause of death worldwide among women of childbearing age, and the number of infants born with HIV remains high— around 370,000 in 2009, according to UNAIDS.

The issue of outreach and education—getting the message out to pregnant women—was emphasized by a number of speakers. Advocates need to show skeptical communities that PMTCT services benefit both mother and child, stressed Elaine Abrams, M.D., senior research director at the International Center for AIDS Care & Treatment Programs (ICAP) and a professor at Columbia University. “We’re saving two lives here since we’re launching a program of care and treatment for women and their babies,” she said.

Mothers2Mothers, an Africa-based program that trains HIV-positive mothers to conduct outreach with other women about the benefits of getting tested—and, if necessary, treated—seeks to fill the gaps in such outreach, said Mitchell Besser, M.D., founder and medical director of the organization. Besser said that the majority of people living with HIV/AIDS are in Africa, yet only 3 percent of the world’s medical personnel are on the continent. HIV-positive mothers who have success stories about their own HIV-negative children can help fill the enormous gaps in outreach and education.

“A nurse might see 90 patients in a single day, and there are 16 separate tasks related to PMTCT,” Besser said. “Mothers in our organization are trained every year, and they often know more than the local doctors.”

The Elizabeth Glaser Pediatric AIDS Foundation also helps train ambassadors to conduct community outreach and education about HIV and PMTCT. But Laura Guay, M.D., vice president of research at the foundation, noted that while commercial businesses have found successful ways to reach small villages in even the most remote sections of Africa, PMTCT services often remain out of reach. “If a woman can buy a Coca-Cola, she should have access to PMTCT services,” said Guay. “This should be our goal.”